Global burden of cancer attributable to HIV: a worldwide incidence analysis

BACKGROUND: People living with HIV are at increased risk of multiple infection-related cancers due to HIV-driven immunosuppression. However, the global burden of cancer attributable to HIV remains unestimated. We aimed to comprehensively estimate the global and regional cancer burden attributable to HIV in 2022, and to understand geographical disparities in this burden. METHODS: Nine cancer types considered causally linked to HIV infection were assessed in this worldwide incidence analysis: Kaposi sarcoma; non-Hodgkin lymphoma; Hodgkin lymphoma; and cervical, anal, penile, vulvar, vaginal, and conjunctival cancer. Cancer-specific population attributable fractions (PAFs) were calculated, primarily from meta-analyses reporting relative risks and HIV prevalence estimates sourced from UNAIDS 2023. PAFs were applied to national cancer incidence estimates from GLOBOCAN 2022 to estimate the numbers and age-standardised incidence rates (ASIRs) of HIV-attributable cancers for 185 countries and territories. FINDINGS: In 2022, 0·4% of global cancer cases (81 300 of 19 million) were estimated to be attributable to HIV, largely driven by cervical cancer (n=30 500, HIV-attributable cancer-specific PAF 4·6%), Kaposi sarcoma (n=24 500, 70·6%), and non-Hodgkin lymphoma (n=12 800, 2·4%). 57 300 (70·5%) of the 81 300 HIV-attributable cancer cases occurred in Africa, particularly in eastern (33 800 41·6% cases) and southern Africa (14 000 17·2% cases), where HIV was the cause of more than 10% of all cancers. ASIRs of HIV-attributable cancer were lowest in Asia (0·2 per 100 000) and reached 27·6 per 100 000 in southern Africa. The relative importance of HIV-attributable cancers varied globally, with cervical cancer accounting for 40·8% (23 400 of 57 300 cases) of HIV-attributable cancer in Africa, but less than 10% in North America (200 5·0% of 4000 cases) and in northern and western Europe (100 5·3% of 1900 cases), where anal cancer (900 22·5% and 500 26·3% cases), Kaposi sarcoma (900 22·5% and 500 26·3% cases), and non-Hodgkin lymphoma (1400 35·0% and 500 26·3% cases) were more common. INTERPRETATION: The absolute and relative HIV-attributable cancer burden varies globally. These data can inform region-specific planning and evaluation of HIV control, as well as cancer-specific interventions such as vaccination and screening, to reduce the infection-related cancer burden in people living with HIV. FUNDING: None.